Middle Mediastinum: II Flashcards
Identify the indicated features of the left ventricle
-
bicuspid/mitral valve between left atrium & ventricle
- anterior & posterior papillary muscles
- Really, the entirety of the left ventricle is composed of trabeculae carneae
Describe the tissue difference in the left ventricular outflow tract
What are some important clinical considerations for this part of the heart?
- more muscular portion deeper into the ventricle
- becoming more membranous
- leading to the semilunar valve entering into the aorta
- problems with these valves usually occur on this side b/c high pressure pumping to the body
- can casue damage, calcification
- very close to anterior leaflets of the mitral valve, making repair challanging
Idenfity the valves in the provided image
Identify the cusps of each of the valves
Fill out the provided table
Identify the margins of the heart indicated by the arrows
- Red:
- inferior/acute
- Blue
- obtuse
- green
- left margin
- purple
- right margin
What is tricky about the right marginal artery?
it is traveling along the the acute (inferior) margin – NOT the right margin
What is the clinically important arterial variation that can occur in the heart?
Identify the indicated branches & name for the 2 situations
- The variations a dependent on where the posterior interventricular branch comes from
- if it is off the right coronary artery = right dominant
- 67%
- if it is off the left coronary artery or the = left dominant
- 15%
- if it is off the right coronary artery = right dominant
Describe the pattern of blood supply to the left ventricle in right dominant & left dominant hearts
- Right Dominant
- anterio 2/3 interventricular septum fed by left anterior descending artery
- posterior 1/3 of interventricular sulcus is fed by the right coronary
- Left Dominant
- entire left ventricle is fed by left coronary
- important for looking at coronary artery disease & the impact on the ventricle
- if lose left coronary artery in left dominant, you’re dead
- if lose left coronary artery in right dominant, still need intervention, but may have chance
Fill out this table!
Where are common sites of coronary occulsion?
- Left coronary artery
- circumflex branch
- anterior interventricular branch
- Right coronary artery
- main stem
- on posterior side
- posterior interventricular branch
Identify the veins indicated in the provided image
Describe their trajectory
- Great cardiac vein (Nile of Veins)- red
- sternocostal surface
- anterior interventricular vein
- coronary sinus
- right atrium
- right next to inferior vena cava
- Middle cardiac vein- yellow
- diaphragmatic surface
- posterior interventricular vein
- dump into coronary sinus
- Small cardiac vein- mustard
- acute margin
- into coronary sinus
- Posterior cardiac vein (Posterior Vein of Left Ventricle)- pink
- obtuse margin
- left ventricle
- obtuse margin
What is this an image of & what are the boundaries?
Left coronary angiogram
What is this an image of & what are the boundaries?
Identify the indicated aspects of teh cardiac conducting system
What nerve provides parasympathetic innervation to the heart? Physiologic response?
What nerve provides sympathetic innervation to the heart? Physiologic response?
** not tested this block
- Cadiac Plexus
- nodes receive sypathetic & parasympathetic innevation
- rest is only sympathetic
- Parasympathetic
- Vagus nerve
- Decrease heart rate / force of contraction
- Sympathetic
- neurons
- lateral horns
- T1-4
- preganglionic sympathetic fibers
- sympathetic trunk ganglia
- postganglionic fibers in Cardiac branches to cardiac plexus
- increase heart rate / force of contraction
- neurons
What conditions lead to heart pain? How does it present & what is the distribution?
- Respond to
- ischemia
- accumulation of metabolic products
- heart pain
- angina (pectoris)
- severe constricting chest pain
- Pericadium pain
- phrenic nerves (C3-5)
- sensory & pain
- phrenic nerves (C3-5)
